These Two Teens Aren’t Just Sisters — They’re Twins

When Lucy and Maria Aylmer tell people they are twins, disbelief is one response.

The 18-year-olds from Gloucester, U.K. are two of the five children born to their Caucasian father and “half-Jamaican” mother, World Wide Features reports. While their other siblings have a blend of features from their parents, Lucy and Maria are opposites: Lucy has fair skin and red hair, while Maria has caramel skin and dark hair.

Lucy, left, studies art and design at Gloucester College. Maria studies law and psychology at Cheltenham College.“No one ever believes we are twins because I am white and Maria is black,” Lucy said, according to World Wide Features. “Even when we dress alike, we still don’t even look like sisters, let alone twins. When we’ve met friends for the first time they never believe we are twins and they have even made us produce our birth certificates to prove that we are actually twins.”Fraternal twins develop from two eggs fertilized by separate sperm cells. The BBC reports that for a biracial couple expecting twins, there is about a 1 in 500 chance those twins will have different skin colors.The Aylmers are proud of their uniqueness.

“Now we have grown older, even though we still look so different, the bond between us is much stronger,” Lucy said. “Now we are proud of the fact that we are each other’s twin sister. Maria loves telling people at college that she has a white twin – and I’m very proud of having a black twin.”

For decades, many dietary recommendations have revolved around consuming a low percentage of your daily calories from fat. It has been widely thought that doing so would reduce your chance of having coronary heart disease. Most of the evidence for that recommendation has come from epidemiologic studies, which can be flawed.

Use of these types of studies happens far more often than we would like, leading to dietary guidelines that may not be based on the best available evidence. But last week, the government started to address that problem, proposing new guidelines that in some cases are more in line with evidence from randomized controlled trials, a more rigorous form of scientific research.

Sometimes we have to settle for epidemiologic or other less reliable studies because we can’t do a randomized controlled trial to prove causality. We’ll never have one for smoking and cancer, for instance, because the evidence from cohort and case-control studies, which are observational and not interventional, is so compelling that telling a random population to smoke “to see if it’s harmful” would be unethical. But there’s no reason we couldn’t randomly assign people to diets.

It turns out that we have. In fact, randomized controlled trials existed when the previous low-fat guidelines were published. It appears they were ignored.

Just recently, a study was published in the journal Open Heart in which researchers performed a systematic review and meta-analysis of the randomized controlled trials that were available when those guidelines were announced. They wanted to explore what evidence those creating the guidelines might have been able to consider at the time.

Before 1983, six randomized controlled trials involving 2,467 men were conducted. None were explicit studies of the recommended diet (and none involved women), but all explored the relationship between dietary fat,cholesterol and mortality. Five of them were secondary prevention trials — meaning that they involved only men with known problems already. Only one included healthy participants, who would be at lower risk, and therefore would be likely to have less benefit from dietary changes.

That’s a lot of participants. Moreover, many of them were at high risk. And in all of them, there was no significant difference among them in the rate of death from coronary heart disease. There were also no differences in mortality from all causes, which is the metric that matters.

The study did show that cholesterol levels went down more in the groups that ate low-fat diets. Some have used this as justification for a low-fat diet. But the difference between them was small. Mean cholesterol went down 13 percent in the intervention groups, but it went down 7 percent in the control groups. And these groups didn’t have different clinical outcomes, and that’s what we really care about.

Small changes in cholesterol levels from dietary changes also aren’t surprising to those who follow the research. About 70 percent of people are thought to be “hyporesponders” to dietary cholesterol. This means that after consuming three eggs a day for 30 days, they would see no increase in their plasma cholesterol ratios. Their cholesterol levels have almost no relationship to what they eat.

Don’t take my word for it. Again, there have been randomized controlled trials in this area. In 2013, researchers published a systematic review of all studies from 2003 or after. Twelve met the researchers’ criteria for inclusion in the analysis, and seven of them controlled for background diet. Most of the studies that controlled for background diet found that altering cholesterol consumption had no effect on the concentration of blood LDL (or “bad”) cholesterol. A few studies could detect differences only in small subgroups of people with certain genes or a predisposition to problems.

In other words, in most studies, all people didn’t respond. In the rest, only a minority of patients responded to changes in dietary cholesterol.

Did recommendations change when these studies were published? No, but they got closer to changing on Thursday, when a government committeeurged repeal of the guideline that Americans limit their cholesterol intake to 300 milligrams a day, saying, “Cholesterol is not a nutrient of concern for overconsumption.” I’m sure this will come as a surprise to a vast majority of Americans, who for decades have been watching their cholesterol intake religiously. (The change won’t be official until it is approved by the Department of Health and Human Services and the Department of Agriculture, but they usually closely follow the committee’s recommendations.)

I wrote here at The Upshot not long ago about how a growing body of epidemiologic data was pointing out that low-salt diets might actually be unhealthy. But randomized controlled trials exist there, too. A 2008 study randomly assigned patients with congestive heart failure to either normal or low-sodium diets. Those on the low-sodium diet had significantly more hospital admissions. The “number needed to treat” for a normal-sodium diet above a low-sodium diet to prevent a hospital admission in this population was six — meaning that for every six people who are moved from a low-sodium diet to a normal diet, one hospital admission would be prevented. That’s a very strong finding.

Let’s not cherry-pick, though. A systematic review of randomized controlled trials of salt intake was published last year. Eight trials involving more than 7,200 participants looked at whether advising patients to cut down on salt, or reducing sodium intake, affected outcomes. None of the trials, including ones involving people with both normal and high blood pressure, showed a reduction in all-cause mortality.

Only one trial even showed an effect on death from cardiovascular causes, like heart attack or stroke. It was conducted on residents of an assisted-living facility who had high blood pressure — hardly representative of the population as a whole, which is what dietary guidelines are supposed to cover.

I’m pretty immersed in the medical literature, and all of this is still shocking to me. It’s hard to overestimate the effect of the dietary guidelines. Hundreds of millions of people changed their diets based on these recommendations. They consumed less fat, they avoided cholesterol and they reduced their intake of salt.

Since pretty much all calories come from fat, protein or carbohydrates, reducing your consumption of one means that you have to increase your consumption of another. (We are not talking here about recommendations for the total amount of calories you should eat. These recommendations assume you’re eating the proper amount of calories, and seek to govern the proportion of nutrients within them.)

So, as the guidelines have recommended cutting down on meat, especially red meat, this meant that many people began to increase their consumption of carbohydrates.

Decades later, it’s not hard to find evidence that this might have been a bad move. Many now believe that excessive carbohydrate consumption may be contributing to the obesity and diabetes epidemics. A Cochrane Review of all randomized controlled trials of reduced or modified dietary fat interventions found that replacing fat with carbohydrates does not protect even against cardiovascular problems, let alone death.

Interestingly, the new dietary recommendations may acknowledge this as well, dropping the recommendation to limit overall fat consumption in favor of a more refined recommendation to limit only saturated fat. Even that recommendation is hotly contested by some, though. The committee is also bending a bit on salt, putting less emphasis on the 1,500-milligram daily limit on sodium for special populations, in light of the mounting evidence that too little sodium may be as bad as too much, if not worse.

It is frustrating enough when we over-read the results of epidemiologic studies and make the mistake of believing that correlation is the same as causation. It’s maddening, however, when we ignore the results of randomized controlled trials, which can prove causation, to continue down the wrong path. In reviewing the literature, it’s hard to come away with a sense that anyone knows for sure what diet should be recommended to all Americans.

I understand people’s frustration at the continuing shifts in nutrition recommendations. For decades, they’ve been told what to eat because “science says so.” Unfortunately, that doesn’t appear to be true. That’s disappointing not only because it reduces people’s faith in science as a whole, but also because it may have cost some people better health, or potentially even their lives.

The Skinny Carb

By this time of year, many peoples’ best-laid New Year’s Resolutions have died, just seven short weeks after they were born. One reason why it’s difficult to lose weight—the most common resolution—is that dieting is so confusing.

For instance, the American Heart Association’s recommended diet is one of the most effective food plans out there. It’s also one of the most complicated. It requires, according to a recent study, “consuming vegetables and fruits; eating whole grains and high-fiber foods; eating fish twice weekly; consuming lean animal and vegetable proteins; reducing intake of sugary beverages; minimizing sugar and sodium intake; and maintaining moderate to no alcohol intake.” On top of that, adherents should derive half of their calories from carbs, a fifth from protein, and the rest from fat—except just 7 percent should be saturated fat. (Perhaps the goal is to keep people busy doing long division so they don’t have time to eat food.)

It’s a lot to remember, and nutritional information is already notoriously contradictory. So rather than put people on a complex diet, a group of researchers recently decided to test whether they could still get people to lose weight and boost their heart health by telling them to do just one thing: Eat more fiber.

Researchers found 240 participants and divided them into two groups. One group was instructed to eat the American Heart Association, or AHA, diet, including shaving 500 to 1,000 calories off of their normal food intake. The other was simply told to eat more fibrous foods. High-fiber foods include fruit, legumes, whole grains, and some vegetables. (It’s recommended that adults eat about 25 to 30 grams of fiber per day, but very few people do this.)

After a year, the more-fiber group had lost 2.1 kilograms, or about 4.6 pounds, according to results published recently in the Annals of Internal Medicine. The AHA group, which had been following a much more complicated eating regimen, lost just half a kilogram more, or six pounds. It was a pretty small difference, but the AHA group suffered greatly for it: They were cutting more than twice as many calories per day, around 400, as the fiber group had been. Fiber is also a part of the AHA diet, but the fiber group was eating about twice as much of it as the other participants. There was no difference in blood pressure or fasting glucose levels between the groups at the end of the experiment. In other words, the people killing themselves to meet a raft of rules did roughly as well as the people who were simply eating more beans and apples.

Changes in Weight and Insulin Levels Over Time

Annals of Internal Medicine

“A dietary intervention focusing on a targeted fiber goal may be able to achieve clinically meaningful weight loss similar to the widely applied, but more intense, AHA dietary guidelines,” the authors, who were from the University of Massachusetts and elsewhere, wrote. They think this might be because, as past studies have suggested, it’s easier to follow one dietary rule than it is to adhere to a whole new life plan.

This might seem like yet another dubious miracle cure of the sort peddled by TV doctors, but it’s really not. Most people eat only about half as much fiber as they should. Foods that are high in fiber tend to be filling and, as far as caloric impact goes, are more of a swan dive than a cannon ball. A handful of high-fiber carrots can produce a feeling of satiety, but they don’t cause as much waistline damage as the same number of KFC hot wings.

Of course people should strive to eat as overall healthfully as they can, or desire to. Americans have been steered wrong by one-note dietary guidelines before. Still, we are nonetheless always on the hunt for one simple trick for weight loss. Fiber isn’t necessarily one, but it’s a good place to start.

Every five years, the Department of Health and Human Services, along with the Department of Agriculture, issues “Dietary Guidelines for Americans,” a federal publication that has far-reaching implications on what we eat. The guidelines affect everything from the way companies can advertise their products, to what’s in your child’s school lunch, to the diet advice offered up by nearly every doctor and nutritionist in the country.

Remember the food pyramid from when you were growing up? Today’s iteration, MyPlate, relies on these guidelines as well. They’re also the basis for the information on nutrition facts labels on just about all food packaging.

So you can see why so many people are anxiously awaiting the 2015 update.

The 112-page report from 2010 included 23 recommendations for the general population and six additional recommendations for specific population groups, such as pregnant women. The three major goals emphasized were:

• Balance calories with physical activity to manage weight.

• Consume more of certain foods and nutrients such as fruits, vegetables, whole grains, fat-free and low-fat dairy products and seafood.

“Cholesterol is not considered a nutrient of concern for overconsumption.”

Inside the advisory report

Sure enough, there it is, buried on page 91 of the 572-page Scientific Report of the 2015 Dietary Guidelines Advisory Committee: “Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day. The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum (blood) cholesterol, consistent with the AHA/ACC (American Heart Association / American College of Cardiology) report. Cholesterol is not a nutrient of concern for overconsumption.”

What has foodies buzzing is that this is somewhat of a tectonic shift regarding one of the main nutritional designations of the foods we eat. Cholesterol has been a prominent part of dietary warnings and guidelines since the American Heart Association put the compound in its crosshairs more than half a century ago.

Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, told CNN: “The idea we need to limit saturated fat and cholesterol shifted Americans from a well-balanced diet to high-sugar diets, which made people eat more and get fatter.”

The reality, according to Nissen, is that only 15% of circulating cholesterol in the blood comes from what you eat. The other 85% comes from the liver. “So if you go on a diet,” he says, “you’re not changing your cholesterol very much.” Still, nutritionists are not recommending you go out and binge on cheeseburgers and fries.

A lot is riding on this decision. Foods that are high in cholesterol, like eggs, shrimp and lobster, could see a major uptick in sales. These foods, perhaps limited inside — or banished from — your home, could make a big comeback.

Who’s telling you what to eat

The 14 outside experts who made up the 2015 Dietary Guidelines Advisory Committee are nationally recognized in the fields of nutrition, medicine and public health.

In a letter to the HHS and USDA secretaries, 2015 DGAC chairwoman Barbara Millen highlights the major diet-related health problems she says we’re facing and must reverse.

“More than two-thirds of adults and nearly one-third of children and youth are overweight or obese. These devastating health problems have persisted for decades, strained U.S. health care costs, and focused the attention of our health care system on disease treatment rather than prevention. They call for bold action and sound, innovative solutions.”

Millen hopes the report will “establish a ‘culture of health’ at individual and population levels and, in so doing, make healthy lifestyle choices easy, accessible, affordable and normative — both at home and away from home.”

“Dramatic paradigm shifts are needed to help individuals and families take more active roles in their personal health and to incentivize health care and public health services, programs, and research to focus more on prevention and personal diet and lifestyle management.”

What’s wrong with the American diet

The report identifies underconsumed “shortfall nutrients,” including vitamins A, D, E and C, as well as folate, calcium, magnesium, potassium and fiber.

For adolescent and premenopausal females, iron is also considered a shortfall nutrient.

The DGAC singles out two nutrients which are overconsumed: sodium and saturated fat.

No surprise, that’s the result of eating too many refined grains, solid fats and added sugars.

The committee was cautiously optimistic about one age group: Young children (ages 2-5) are the only ones consuming the recommended amount of fruit and dairy, so perhaps there’s hope for the future. The report urges a better understanding of how to maintain and encourage good eating habits that are started early in life.

What you should be eating

It’s not just what we eat, it’s how we eat it. When looking into the common characteristics of healthy diets, the committee focused on research examining dietary patterns, because “the totality of the diet — the combinations and quantities in which foods and nutrients are consumed — may have synergistic and cumulative effects on health and disease.”

A healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or nonfat dairy, seafood, legumes and nuts; moderate in alcohol; lower in red and processed meat; and low in sugar-sweetened foods and drinks and refined grains.

The DGAC encourages dietary patterns that are low in saturated fat, added sugars and sodium. The goals for the general population are:

• Less than 2,300 milligrams of dietary sodium per day.

• Less than 10% of total calories from saturated fat per day.

• A maximum of 10% of total calories from added sugars per day.

“Sodium, saturated fat, and added sugars are not intended to be reduced in isolation, but as part of a healthy dietary pattern that is balanced, as appropriate, in calories,” the report states. “Rather than focusing purely on reduction, emphasis should also be placed on replacement and shifts in food intake and eating patterns.”

“Sources of saturated fat should be replaced with unsaturated fat, particularly polyunsaturated fatty acids. Similarly, added sugars should be reduced in the diet and not replaced with low-calorie sweeteners, but rather with healthy options such as water in place of sugar-sweetened beverages. For sodium, emphasis should be placed on expanding industry efforts to reduce the sodium content of foods and helping consumers understand how to flavor unsalted foods with spices and herbs.”

What’s next?

“For decades, the Dietary Guidelines for Americans have been at the core of our efforts to promote the health and well-being of American families,” said HHS Secretary Sylvia Burwell and Agriculture Secretary Tom Vilsack in a joint statement. “Now that the advisory committee has completed its recommendations, HHS and USDA will review this advisory report, along with comments from the public — including other experts — and input from other federal agencies as we begin the process of updating the guidelines.”

Forget Barefoot; New Trendsetter in Running Shoes Is Cushioning

Leo Manzano, an Olympic silver medalist, said his plantar fasciitis disappeared after he started using the more-cushioned shoes of Hoka One One.CreditJulia Robinson for The New York Times

Athletes who spent the past few years embracing or scorning barefoot running can now consider whether increasingly popular “maximalist” shoes — with their chunky, heavily cushioned soles — are the sport’s new wonder product.

Some dismiss the shoes as gimmicky, or just silly-looking. Others, including injury-prone joggers and Olympians, are apostolic converts.

Leo Manzano, an Olympic medalist in the 1,500 meters, runs in the most popular maximalist shoe brand, Hoka One One, which has double the cushioning of standard running shoes. Plagued by plantar fasciitis, an inflammation in his foot, Manzano said the condition disappeared just a week after he tried the shoes last March. In July, he became the fifth fastest American in the 1,500. Manzano is now sponsored by Hoka, which has been accruing a roster of competitive distance runners. “They’re not your normal shoe, but I actually think they’re better than normal,” Manzano, 30, said. “When I first saw them, because they’re so big, I thought they’d be heavy. But they’re incredibly light. My legs felt really fresh after a long run in them. It’s like running on a cloud.”

The Stinson Lite model from Hoka One One, whose initial customers were ultrarunners who felt extra cushioning helped protect their legs from the shock of running long races.CreditHoka One One

Hoka One One’s initial customers were ultrarunners, who felt the extra cushioning helped protect their legs from the shock of running up to 200-mile races. But the brand is gaining a following with more recreational athletes. Last year it sold more than 550,000 pairs, which cost $130 to $170 each, and its $48 million in sales were up 350 percent from 2013. Founded in 2009 by French athletes and based in the Bay Area, the company was acquired in 2012 by Deckers Brands, which also owns UGG Australia and Teva.

Solutions for injury prevention, on the extremes of the athletic footwear spectrum, have reached panacea-like proportions in recent years. The rise of maximalism counters the fall of minimalism, particularly the barefoot running movement. Boosted by terms like “proprioception” (feel for the road) and the best-selling book “Born to Run,” which argued that the human body was naturally built for running without corrective footwear, American sales of minimalist shoes peaked at $400 million in 2012.

They have been declining since. The most visible minimalist shoe was theVibram FiveFinger, which looked like gloves for your feet. But in May, Vibram agreed to settle a lawsuit that alleged the company made false claims about the health benefits of its footwear.

“People are frustrated, and we’re told so often there’s a magic shoe that will stop our injuries,” said Jay Dicharry, a biomechanist in Bend, Ore., and author of “Anatomy for Runners.” “But that’s just not true.”

Rich Mendelowitz, a longtime runner from Arlington, Va., started wearing Hokas while training to qualify for the Boston Marathon last year at age 55.

“I’ve had more comments on these shoes than I’ve had hot meals since wearing them,” he said. “But as a relatively older runner, staying injury-free is particularly important to me. I’m convinced that these are the shoes that will extend your running life.”

Mindful of the Vibram lawsuit, Hoka has been careful not to make any evidence-based health claims, and few studies exist on the effectiveness of extreme cushioning. One prominent University of Colorado study in 2012found that the benefits of cushioning underfoot were finite: 10 millimeters of cushioning on a treadmill saved energy, while 20 millimeters of cushioning did not.

Lauren Fleshman, a national champion in the 5,000 meters, likened the maximalist upswing to past footwear phenomena, now rejected as passé.

“To me, maximalist shoes fall right in the line of every other shoe trend,” she said. “There’s some good reasoning, but we don’t know enough about how it affects the body longer term, and we won’t know until everyone has been using it a while and all the other research comes out about how it destroys your body or whatever, and then there’s a lawsuit, and then there’s a campaign about how to use the technology properly, and then in the midst of all this confusion the next trend takes off. There is no shoe savior coming for us.”

Dicharry, the biomechanist, suggested that extreme shoes like the Hokas might be best used in moderation.

“Some people have a road bike, a commuter bike and a mountain bike, and they all have their purpose,” Dicharry said. “Maximalism is the new fat-tire bike of running shoes.”

Despite his devotion to Hokas, Manzano said he still ran short distances barefoot to keep his feet strong.

Jonathan Beverly, the shoe editor for Runners World, said maximalist shoes like the Hoka incorporated many of the qualities that made minimalism popular, while also mitigating the impact of running on hard surfaces.

“The benefit of the big sole is actually similar to what the minimal movement did; with both types of shoes you have to keep your body and your center of gravity above your feet,” Beverly said. “So you’re running with the same posture as you would if you were barefoot, but with all this cushioning.”

A move toward extra cushioning extends beyond the Hokas to more mainstream brands. Sales of one of Brooks’s most cushioned shoes, Glycerin, increased 29 percent in 2014, and the company also added a new higher-cushioned shoe last year.

“When we were doing the research behind lightweight shoes, 70 to 80 percent of runners we surveyed felt that cushioning was the attribute they most wanted,” said Carson Caprara, a senior product manager for Brooks Running. “Our goal is not to make it look like you’re wearing something crazy different. It looks for the most part like a regular running shoe, but it’s done differently. It’s designed to make you feel like you’re not hitting the ground.”

Dicharry said maximalist shoes were not necessarily suited for running fast.

“They could be good for easy runs,” he said. “But when you’re doing a speed workout, you want to go back to firmer footwear that helps your body explode off the ground.”

Manzano felt that the higher cushioning of his Hokas suited his higher mileage.

“I run 70-80 miles a week, which is extreme, and I was suffering from extreme issues,” he said. “So I need extreme support.”

Ultimately, most runners may need to resort to more traditional solutions.

“Of course what’s on your feet is important,” Dicharry said. “But there is a lot of evidence to show that people who spend more time improving their bodies as opposed to shopping for shoes are the ones who are going to run better.”